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Nodular calcium poses a great challenge during coronary intervention. The presence of nodular calcium is associated with poor post-procedural outcomes. Without debulking the nodular calcium, it is extremely difficult to pass the coronary hardwires including the balloons and drug-eluting stents across the lesion. Application of high atmospheric pressure during balloon inflation in the presence of nodular calcium leads to vessel perforation which is a catastrophe during coronary intervention. We report a rare case of nodular calcium in the left main coronary artery bifurcation which was successfully cracked with pulses of intravascular lithotripsy in a 75-year-old male with old anterior wall myocardial infarction. Although rotablation and orbital arthrectomy have a role in modifying calcium nodules in coronary arteries, intravascular lithotripsy was also successful in debulking the nodular calcium in the left main coronary artery bifurcation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mahanta et al.)

Kyphoscoliosis is a well-known spinal deformity. The abnormal curvature in both the coronal and sagittal planes presents unique challenges during pregnancy. This case discusses the management of a 27-year-old primigravida with thoracolumbar kyphoscoliosis, who underwent an emergency cesarean section at 39.3 weeks of gestation. An interdisciplinary team consisting of an obstetrician, pulmonologist, orthopedic surgeon, anesthesiologist, and physiotherapist collaborated in her care. In such cases, successful outcomes require a tailored approach that prioritizes maternal-fetal well-being and minimizes potential complications associated with complex spinal deformity during pregnancy and childbirth., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Deshmukh et al.)

We report a rare case of multiple nodular calcium in the left anterior descending coronary artery in an octogenarian presenting with unstable angina. Dilatation with the noncompliant and scoring balloon could not yield the nodular calcium and it was only the cutting balloon that could yield the nodular calcium and successful coronary angioplasty could be accomplished with good angiographic results with distal Thrombolysis in Myocardial Infarction (III) flow. This case demonstrates the unique role of cutting balloons in the angioplasty of coronary lesions with multiple nodular calcium., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

We report an extremely rare case of gooseneck snare-assisted retrieval of an embolized coronary guidewire from the aortic arch in an elderly male scheduled for a transradial coronary angiogram for unstable angina. In this case, the proximal end of the embolized coronary guidewire could not be retrieved from the brachial artery nor the roomy aortic root using a flower petal snare. The key takeaway from this case is that an embolized coronary guidewire can be successfully retrieved with a gooseneck snare from its proximal end in a moderately spacious area like the aortic arch., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

We report an extremely rare case of long-standing (> six months) minimal pericardial effusion attributed to dermatomyositis. The patient was inadvertently administered antitubercular drug therapy for three months after which the patient developed significant weight loss, extreme anorexia, nausea, and vomiting refractory to conventional management. The key message in the manuscript is that even indolent dermatomyositis can present solely as an unexplained pericardial effusion in an individual., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

We report a first and interesting case of balloon-assisted deployment of a dislodged coronary stent. While performing a calcified left circumflex coronary artery (LCX) intervention, the drug-eluting coronary stent was dislodged in the osteoproximal segment of the calcified and tortuous LCX. The dislodged stent was rewired, progressively dilated with multiple balloons and, finally, a larger, balloon-mounted stent was pushed forward, positioned across the coronary lesion and deployed, resulting in distal thrombolysis in myocardial infarction (TIMI) III flow with good angiographic results. Rewiring the dislodged stent with subsequent balloon-assisted deployment in the lesion can be a solution for a dislodged coronary stent in the proximal vessel., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

We report a rare case of radial arteriovenous fistula in a middle-aged person after a successful transradial percutaneous coronary intervention. Early release of manual radial compression was the culprit behind the development of radial arteriovenous fistula. Early surgical repair of the radial arteriovenous fistula resulted in the complete resolution of distal forearm symptoms in the abovementioned patient. It is advised for young interventional cardiologists to apply a compressive bandage over the radial artery for a minimum period of one hour to get rid of this extremely rare complication., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

We report an extremely rare case of spontaneous closure of grade 1 coronary perforation by the snowplow phenomenon during the revascularization of a subtotal occlusion in the left anterior descending coronary artery. Coronary artery perforation is usually a nightmare during coronary intervention in the cardiac catheterization laboratory. While large coronary perforation requires the deployment of a covered stent, small perforations require heparin reversal, prolonged balloon inflation, deployment of small coils, or gel foam closure. The coronary segment with a small perforation was stented with a drug-eluting stent (DES), which might have resulted in the shifting of the fatty plaque toward the perforation and subsequently sealing the coronary perforation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

Adenosine is a widely used pharmacologic agent in the field of cardiology, predominantly for the termination of supraventricular tachycardias and diagnostic purposes. Most of the side effects are short-lasting due to its very short half-life. Fatal complications of adenosine are rare but can include ventricular fibrillation, ventricular tachycardia, and asystole. Proper medical supervision and monitoring are crucial to minimize risks. We report a unique case of a second-degree type 2 sinoatrial node exit block following intravenous adenosine administration in a 25-year-old male presenting with palpitations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahanta et al.)

The left anterior descending coronary artery (LAD) arises from the left coronary sinus about 10-12 mm above the annular plane and traverses down the interventricular groove. With deep septal and diagonal branches, it supplies the left side of the heart. Here, we describe an extremely rare case of anomalous origin of the LAD from the right coronary artery, which courses epicardially over the right side of the heart with its ramifying branches, which can be described as the "right anterior descending coronary artery (RAD).", Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Thrombosuction plays a controversial role during primary percutaneous intervention (PCI). Landmark trials have demonstrated no additional role of thrombosuction during primary percutaneous intervention towards improving mortality and outcome during primary percutaneous intervention. We describe a rare elective coronary angioplasty where only aggressive thrombosuction (almost 150-200 mL) of blood from the coronary artery established the antegrade coronary flow and saved an octogenarian from impending sudden cardiac death (SCD). The present case describes the promising role of aggressive thrombosuction even during elective coronary intervention when a large dissection ends in acute total thrombotic occlusion of a coronary artery jeopardizing the antegrade coronary perfusion., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Congenital anomalies in the shape of the coronary arteries are extremely uncommon to encounter in routine clinical practice in interventional cardiology. In this study, we describe two uncommon shape anomalies of the left main coronary artery, that is, U-shaped left main coronary artery and L-shaped left main coronary artery. These anomalies were observed in two consecutive patients who presented with atypical chest pain and exertional shortness of breath. These uncommon shape anomalies of the left main coronary artery hold their clinical significance during intervention as those require robust guide catheter support during the difficult passage of the routine coronary hardwires., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Torsades de pointes (TdP) is a less common type of ventricular tachycardia (VT) characterized by polymorphic VT of changing amplitude and characteristic twists around the isoelectric baseline. It is almost always associated with QT interval prolongation. Unless immediately intervened, it can lead to ventricular fibrillation followed by cardiac arrest. We report a case of a patient with bradycardia-induced TdP who presented to the emergency room with cardiac arrest., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Coronary artery dissection can occur after post-balloon inflation; however, a very long-segment coronary dissection (>50 mm) is a rare occurrence during routine coronary interventions. Here, we report an extremely rare case of long-segment coronary dissection in the left anterior descending coronary artery (LAD) induced during antegrade revascularization of chronic total occlusion of osteoproximal LAD with stiffer Gaia II wire. The patient had excruciating angina with hemodynamic collapse and acute pulmonary edema; the patient was rescued with long-segment coronary revascularization., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Right coronary artery intervention is usually accomplished with a Judkins right (JR) coronary guide catheter. Abnormal right coronary artery take-off from the right coronary sinus poses difficulty in engaging the right coronary artery with a conventional JR guide catheter. We report a rare case of primary percutaneous intervention of the right coronary artery which was performed with a multipurpose catheter as the patient had an extremely low-lying coronary artery from the coronary sinus where conventional catheters could not engage the right coronary artery in an octogenarian with acute inferior wall ST-elevation myocardial infarction in cardiogenic shock., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

It is extremely rare to come across a single coronary artery during routine interventional cardiology practice. The incidence of single coronary arteries increases across congenital heart diseases. We report an extremely rare case of a single coronary artery arising from the left coronary sinus in an octogenarian presenting with anterior wall non-ST elevated myocardial infarction (NSTEMI) secondary to atherosclerotic occlusion of the proximal left main coronary artery (LMCA). It is often difficult to selectively engage a single coronary artery due to anomalous origin from the sinus; nonselective coronary sinus injection often suffices in visualizing the single coronary trunk dividing into left and right coronary arteries besides demonstrating the associated route and atherosclerotic anomalies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

A ball valve thrombus is a common entity in rheumatic mitral stenosis where a large clot forms in the left atrial appendage, the clot detaches from the left atrial appendage, swirls in the left atrium in a clockwise manner, obstructs the mitral inflow producing cyclic acute pulmonary edema, and likely causes left ventricular outflow tract obstruction producing transient syncope or embolism to the brain producing dense hemiplegia. Besides rheumatic mitral stenosis, ball valve thrombus has been described in post-mitral valve replacement patients and restrictive cardiomyopathy. Left atrial myxoma sometimes rocks across the mitral valve producing the effect of a ball valve thrombus. Right atrial ball valve thrombus has been described after prolonged parenteral nutrition through a central line in intensive care units and in carcinoma patients with cardiac metastasis. We report an extremely rare case of a ball valve thrombus in an obese individual where dyslipidemia was the sole triggering factor for the formation of a ball valve thrombus in the left atrium., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Nodular calcium in the coronary artery poses a great challenge during coronary intervention. Although rotational atherectomy is the preferred modality of treatment of nodular calcium, we treated the left main coronary artery (LMCA) nodular calcium with a scoring balloon during primary angioplasty of an octogenarian with anterior wall myocardial infarction and EKG suggestive of LMCA occlusion. During primary coronary angioplasty, the scoring balloon alone also sometimes suffices in achieving good angiographic results and thrombolysis in myocardial infarction grade III (TIMI III) flow., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mahanta et al.)

Introduction The relationship between the level of anxiety and depression among coronary artery disease (CAD) patients and coronary angiographic findings is ambiguously mentioned in studies. Past evidence shows that the relationship between anxiety and depression with coronary artery disease can be bidirectional. There is a paucity of literature on the association of levels of anxiety and depression with the number of coronary arteries involved in coronary artery disease. Methods This study was conducted in a tertiary care hospital to find the level of anxiety and depression in patients undergoing cardiac catheterization and their association with the numbers of the major coronary artery involved. Patients undergoing cardiac catheterization in the Department of Cardiovascular Science of a tertiary care hospital in India from May 2020 to December 2020 were considered for inclusion in the study. Coronary artery disease was diagnosed based on the combination of clinical, ECG, echocardiography, or biomarker parameters in various combinations. These patients were further subjected to coronary angiogram to know the extent of stenosis and the number of coronary vessels involved in the disease. The level of anxiety and depression was measured by using the Hospital Anxiety and Depression Scale (HADS) during the period of admission and at least 24 hours after diagnosis and at least 12 hours before cardiac catheterization. The data was entered into SPSS software version 22.0 (Armonk, NY: IBM Corp.) for statistical analysis. Chi-square test, Kolmogorov-Smirnov test, and Kruskal-Wallis test were used for the interpretation of data and find an association between severity of anxiety and depression with the number of major coronary vessels involved. Results Anxiety was seen in 83.3% of the patients with 31.5% having severe anxiety. Depression was found in 77.8% with 38.9% suffering from severe depression. The anxiety and depression scores of HADS were significantly higher in those with triple-vessel disease compared to the double-vessel or single-vessel disease. Conclusion Screening and management of anxiety and depression is an essential part of the care of patients with coronary artery disease. People with triple-vessel disease need the most attention and appropriate management of anxiety and depression., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Das et al.)